What is an Orthopedic Trauma Surgeon?

An orthopaedic surgeon is a physician who has completed four years of college, four years of medical school and five years of orthopaedic surgery residency. He or she must also complete three written examinations and pass a state board for medical licensure. An orthopedic surgeon becomes board certified by taking a written exam after residency and then passing a stringent oral examination two years after beginning practice. The American Board of Orthopaedic Surgeons has very strict rules for admission to the board. An orthopedic trauma surgeon is a surgeon who has completed all of the requirements above and also has completed a one year fellowship in orthopedic trauma surgery. Orthopedic trauma surgeons are specialists in management of pelvis fractures, fractures of the acetabulum and peri-articular fractures. Peri-articular fractures are fractures that are very complex and involve the joints such as the knee and ankle (tibial plateau and tibial pilon). There are very few fellowship trained orthopedic trauma surgeons in the United States, and even fewer in Arizona. All of the surgeons at SOTS are fellowship trained and maintain a 100% trauma practice. Orthopedic trauma can affect your mental well-being as well as your physical health. It is important to speak with your doctor regarding any conditions that may adversely affect your ability to heal.

Anterior Hip Replacement

Total hip replacement involves replacing both the proximal femur and the acetabulum (hip socket). The anterior approach to total hip replacement at our Phoenix-area practice utilizes a natural interval between muscles and does not remove tendons or muscles from either the pelvis or femur. This approach is facilitated with the use of the Pro-Fx table designed specifically with this procedure in mind.

The traditional posterior approach to the hip requires removal of tendon and muscles from the bone. This destabilizes the hip and requires adherence to hip precautions after surgery that effect the way you sit, stand, use the bathroom and sleep. With the anterior approach, no hip precautions are necessary and dislocation rates are reduced. Other advantages of the anterior approach include decreased postoperative pain and quicker recovery. Use of an x-ray intra-operatively, which is not possible with traditional approaches, allows the surgeon to more accurately control leg length and make small changes during the operation.

Dr. Brian Miller is one of only two orthopaedic surgeons in Arizona who has fellowship training in the anterior approach to total hip replacement. He has been trained in all three approaches to performing total hip replacements and has chosen the anterior approach because he has seen firsthand its advantages. His experience and training with pelvic and acetabulum fractures, considered by many the most challenging fractures to treat, gives him a comprehensive understanding of the anatomy and workings of the hip joint.
Dr. Gil Ortega performed his first anterior hip replacement in 2002. He learned the anterior hip approach techniques while training at Yale under a pioneer of the approach, Dr. Kristaps Keggi. In the late 1970s,, Dr. Keggi was the first in the United States to present and publish his results using the anterior hip approach for total hip replacements. Dr. Ortega values the mentorship he shares with Dr. Keggi. Although experienced in all approaches to the hip, Dr. Ortega prefers to use the anterior approach for his partial and total hip replacements as he has recognized improved patient outcomes using the anterior approach.

Pelvis Fractures

Fractures of the pelvis are extremely complex injuries that occur after high energy trauma like a fall from a height or a motor vehicle crash. The pelvis is made of three large bones and some of the most powerful ligaments in the body. It is full of major arteries, veins, nerves and organs. An injury to this region requires a huge amount of force and can be extremely damaging to all of these structures. A patient with a pelvis fracture may for example injure the nerves at the bottom of the spinal cord, rupture their bladder or damage the intestines. Recognizing these associated injuries and working with our colleagues in general surgery and urology is part of our expert approach to pelvic fracture management.

Pelvis fracture surgery is highly specialized, and should be done by surgeons who have special training in this field and do several of these procedures a year. Our surgeons were both trained by the world’s leading pelvic fracture surgeons, and they are constantly learning about new techniques and methods.

Fractures of the Acetabulum

The acetabulum is often referred to as the socket part of the hip joint. It is the cup part of the pelvis that wraps around the ball or head portion of the femur to create the hip joint. Fractures of the acetabulum are very complex and severe injuries that occur after high energy trauma such as fall from a height or a motor vehicle crash. These injuries have significant relevance both initially and long term. Many patients with a fracture of the acetabulum also have other major trauma including injuries to the head, chest and abdomen. The orthopaedic trauma surgeon plays a critical role in the initial management of these injuries and the initial stabilization of the patient. The doctors at Sonoran Orthopaedic Trauma Surgeons have extensive experience with critically injured patients.

It has clearly been demonstrated that accuracy of reduction (the quality of the repair of the actual joint surface) is predictive of the patient’s long term outcome. Acetabular fracture surgery is very complex with long arduous dissections and difficult bone work. These procedures should only be done by experienced surgeons who do several a year and have specialized training in pelvic fracture surgery. Our surgeons are trained with some of the world’s leading pelvic fracture surgeons, and they continue to remain up to date on the latest techniques in acetabular fracture management.

Perhaps the most important facet of fractures of the acetabulum to understand is the many complications of both the injury and the surgery to fix them. Patients with acetabular fractures have a high risk of developing arthritis after the injury. This may become so severe that a total hip replacement is necessary. A portion of patients may have nerve or arterial injuries that cause weakness, numbness and pain. We identify these associated injuries as soon as possible and use a multidisciplinary approach to treat these difficult problems. Many patients with these injuries are at risk for other medical problems such as infection or blood clots in the veins of the pelvis and legs. Furthermore, the acetabulum is situated in one of the most eloquent parts of the body. There are numerous large blood vessels, nerves and visceral structures within millimeters of the operative site. Therefore, the importance of an experienced pelvic fracture surgeon can not be underscored enough. Even the hands of the most skilled orthopaedic trauma surgeons, fractures of the pelvis can be complicated by severe bleeding and neurologic injury.

Pelvic and acetabular fractures can be fixed up to 3-4 weeks after the initial injury. It is easier to fix them in the first ten days, but stabilization of a multiply injured patient is of utmost importance. If you or a family member are at another facility and wish to be transferred to the care of Sonoran Orthopaedic Trauma Surgeons, please have your surgeon call our office to arrange a transfer.

Lower Extremity Fractures

Pilon

A “pilon” fracture is a complex fracture of the end of the tibia or shin bone. This injury is very severe because it involves the ankle joint. Long term complications include infection, crooked ankles and debilitating arthritis. The most important factor in treating a pilon fracture is respecting the horrible soft tissue injuries of the skin that occur around them and attempt to get an anatomic reduction of the joint surface that has been disrupted. Years of experience by trauma surgeons around the world have shown that respecting the soft tissue is of utmost importance; therefore, if you have a pilon fracture, you will likely have at least two operations. The first will be to “span” the ankle joint with an external fixator. This keeps the bones in their original length while the bruising subsides. About ten days later the external fixator is removed and the joint itself is opened and repaired.
Tibial Plateau

The tibial plateau is the upper surface of the tibia or shin bone that makes up the bottom half of the knee joint. Fractures of this joint surface are very common in high energy trauma such as auto accidents and pedestrian versus auto. Meticulous management of the skin, muscles, tendons and ligaments is crucial to the successful healing of a tibial plateau fracture. Like all fractures involving joints, plateau injuries should be managed by experienced trauma surgeons who understand the nuances of these complex injuries. Severe plateau fractures are often complicated by compartment syndrome, a condition that results in uncontrolled swelling of muscle and decreased blood flow to the leg. Compartment syndrome is a surgical emergency. Our surgeons have extensive training in the management of tibial plateau fractures. They utilize the latest techniques in minimally invasive surgery and early motion to help patients recover from these severe fractures.
Compartment Syndrome

Compartment syndrome is a surgical emergency that is not an uncommon occurrence in orthopedic trauma. This condition results when an extremity is crushed or injured and bleeding and swelling occurs in the muscle. Each muscle in our body is wrapped in a compartment. As the swelling increases, the pressure in the compartment rises. If the pressure exceeds the patient’s blood pressure, then blood can no longer get into the muscles and the extremity can die. Compartment syndrome can result in limb loss and even death if not treated quickly. The compartments are opened with a knife and the muscle is decompressed. The wounds are closed at a later date or they are covered with a skin graft. Compartment syndrome is most common in the leg, but also occurs in the thigh, arm, forearm and the buttock.
Calcaneus

The calcaneus is the large spongy bone that makes the heel of your foot. Fractures of the calcaneus are rare and often devastating injuries. They occur most often when patients have a fall from a height or are in high energy car accidents. They can be associated with other lower extremity trauma and spinal injuries. A calcaneus fracture changes the shape of the back of the foot, making it difficult to wear shoes. Furthermore, severe calcaneus fractures involve an important joint in the back of the foot called the subtalar joint. The subtalar joint is very important for walking, especially on uneven surfaces.

The calcaneus is a complex bone, and surgery in this region is equally demanding. Even in the most experienced hands the complication rate is as high as 10%. Our surgeons are trained with the world’s leading expert on fractures of the calcaneus, Dr. Roy Sanders. Not all calcaneus fractures are amenable to surgery. The surgeons at SOTS will help you understand your injury and whether or not surgery is needed.

Post-Traumatic Reconstruction

Nonunion

A nonunion is a bone that was fractured and did not heal. There are many types of nonunions. Some bones do not heal because they were not fixed appropriately. Others fail to unite because the bone is infected, the patient is not healthy or perhaps did not follow instructions. Some examples of health risks for nonunion are vascular disease, diabetes, patients with cancer or immune diseases and especially SMOKERS! Cigarette smoke directly inhibits bone healing and has been scientifically shown to prevent healing in all types of surgery. Many patients develop a nonunion for unknown reasons. Orthopaedic surgeons can become frustrated with nonunions and their complexity. We enjoy treating these difficult problems and welcome the most challenging cases.

Nonunions often are complicated by broken hardware and deformity of the bone. This makes these procedures very complex because they require removal of hardware and deformity correction on top of the treatment of the nonunion.

Our surgeons use a methodical approach to treatment of non-unions with collaboration on the behalf of infectious diseases, hyperbaric oxygen, plastic surgery and internal medicine. Nonunion is a biological problem and requires a whole system approach. We use the latest scientifically proven technologies to tackle these challenging problems. If you have a nonunion please call our office for a consultation.
Osteomyelitis

Osteomyelitis is the medical term for infection of bone. This is not an uncommon occurrence after orthopaedic trauma, particularly bad open fractures. Osteomyelitis is a strange diseases and has often been called the great imitator because of its ability to appear like other illnesses. Bone infection can lie dormant for years only to spring back into action later in life. Bone infection often results in bone loss and even amputation. There are many techniques, old and new, for salvage that the surgeons at Sonoran Orthopaedic Trauma Surgeons are capable of utilizing. We have a close relationship with the hyperbaric unit at Scottsdale Healthcare. Hyperbaric oxygen has been shown to be effective in the treatment of osteomyelitis.

We do not treat osteomyelitis associated with diabetic neuropathy or the diabetic foot.

Post-Traumatic Bone Infection

Open fractures of the tibia had a 50% mortality during the civil war of the United States. Imagine, if you had an open shin bone fracture in 1864 there was a 50% chance you would die! Modern antibiotics and surgical techniques have changed this outcome dramatically . . . but the fact still remains that a tibia fracture that penetrates the skin is a serious injury.

Humans of the 21st century enjoy exciting activities like sky diving, bungee jumping, parasailing and motorsports. Unfortunately sometimes these activities lead to life changing injuries. There are many armed conflicts happening around the globe resulting in devastating injuries of the extremities too. Open fractures that occur in high energy situations or in theaters of combat are highly susceptible to chronic infection.

The Doctors at Sonoran Orthopaedic Trauma Surgeons have significant expertise in dealing with chronically infected bones after trauma. We employee the most up to date techniques in surgical, metabolic, hyperbaric and molecular medicine. Osteomyelitis, or bone infection after trauma, is a horrible condition that in many cases is totally debilitating. Patients with these problems must seek experts like our surgeons who have extensive experience in the treatment of chronic bone infection and access to all of the necessary specialists to treat all aspects of the infection.

Often bone infection requires excision of dead and infected bone. In these scenarios, one needs a surgeons who can grow new bone through bone transport mechanisms using the method of ilizarov or modern bone grafting techniques.eded.

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Orthopaedics is the medical specialty that focuses on injuries and diseases of your body’s musculoskeletal system. This complex system includes your bones, joints, ligaments, tendons, muscles, and nerves, and allows you to move, work, and be active.

OrthoInfo is a trusted source of information about musculoskeletal conditions and injuries — how they are treated, as well as how they can be prevented. Our articles and videos are developed by orthopaedic surgeons who are members of the American Academy of Orthopaedic Surgeons. All of the content on our website is peer-reviewed by physician members of the OrthoInfo Editorial Board who are experts in their fields. This peer-review process ensures the accuracy and completeness of our content.

Founded in 1933, the Academy is the preeminent provider of musculoskeletal education to orthopaedic surgeons and others in the world. Its continuing medical education activities include a world-renowned Annual Meeting, multiple continuing medical education courses, and various medical and scientific publications and multimedia materials.

NOTE: This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.